| NPI | 1174584601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 58835) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0061245) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME 0061245) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: AZ 58835) | |
| Enumeration Date | 2006-04-02 |
| Last Update Date | 2021-05-14 |